Playlist

Pituitary Case: 28-year-old Woman with Amenorrhea and Nipple Discharge

by Michael Lazarus, MD

My Notes
  • Required.
Save Cancel
    Learning Material 2
    • PDF
      Slides 01-02-01 Adrenal Pituitary.pdf
    • PDF
      Download Lecture Overview
    Report mistake
    Transcript

    00:01 Let's go on to another case.

    00:03 A 28-year old woman is evaluated for amenhorrhea.

    00:06 She stopped taking her oral contraceptive pill eight months ago in order to get pregnant.

    00:12 Her menstrual cycle has not resumed.

    00:15 She did have normal menses prior to the beginning of oral contraceptives four years ago.

    00:22 She also complains of daily nipple discharge over the last six weeks.

    00:27 Other than the oral contraceptive pill, she takes no other medications.

    00:31 On exam, her vital signs are normal, but she has a white discharge from bilateral nipples.

    00:38 Her thyroid, skin, and visual field exam are normal.

    00:42 Labs are significant for a prolactin level of 86 nanograms per ml, a normal thyroid-stimulating hormone, and a negative pregnancy test.

    00:53 The MRI for pituitary shows a nine millimeter pituitary mass.

    00:58 What is the diagnosis? This young woman has secondary amenhorrhea, the production of abnormal breast milk or galactorrhea, an elevated prolactin levels, and a pituitary mass.

    01:12 She most likely has a prolactinoma in her anterior pituitary causing secondary amenhorrhea, which is the cessation of menses, despite the presence of normal cycles after puberty.

    01:23 Pituitary microadenomas that secrete excessive prolactin cause secondary amenhorrhea due to the inhibition of gonadotropin-releasing hormone in the hypothalamus.

    01:34 We would treat these patients with dopamine agonists.

    01:37 Bromocriptine is a good first-line agent because of its low cost.

    01:41 Cabergoline is better tolerated however because tumor shrinkage is better, but unfortunately, it is more expensive.

    01:50 Always check response to therapy by repeating a prolactin level in one month after commencing treatment.


    About the Lecture

    The lecture Pituitary Case: 28-year-old Woman with Amenorrhea and Nipple Discharge by Michael Lazarus, MD is from the course Pituitary and Hypothalamic Disorders. It contains the following chapters:

    • Pituitary Case: 28-year-old Woman with Amenhorrhea
    • Prolactinoma

    Included Quiz Questions

    1. Prolactinoma
    2. Pituitary tumor producing stalk compression
    3. Laron syndrome
    4. Sheehan syndrome

    Author of lecture Pituitary Case: 28-year-old Woman with Amenorrhea and Nipple Discharge

     Michael Lazarus, MD

    Michael Lazarus, MD


    Customer reviews

    (1)
    5,0 of 5 stars
    5 Stars
    5
    4 Stars
    0
    3 Stars
    0
    2 Stars
    0
    1  Star
    0